Category: Surg Neurol Int

Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture.

Surg Neurol Int. 2012;3:39

Authors: Kim MS, Jung JR, Yoon SW, Lee CH

Abstract
BACKGROUND: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute subdural hematoma (SDH) located in the posterior fossa. We also reviewed the literature, focusing on the location of this intracranial hematoma.
CASE DESCRIPTION: An 83-year-old woman was admitted to our institution with recent sudden headache and dizziness. Magnetic resonance imaging showed a thin collection of blood in the subdural space adjacent to the clivus, along the wall of the posterior fossa, and at the cervical spine level. A right posterior communicating artery aneurysm was diagnosed using computed tomography angiography and digital subtraction angiography. The aneurysm had two lobes, one of which was attached to the right dorsum sellae. The aneurysm was occluded by stent-assisted coil embolization. The patient was discharged 3 weeks after admission with absence of neurological deficit.
CONCLUSION: A ruptured aneurysm of the posterior communicating artery may cause an acute SDH.

Abstract
BACKGROUND: Dural metastases have been found in about 8-9% of patients who died of cancer, in most autopsy series. Dural metastases presenting with chronic subdural hematoma are rare, with only about 55 cases reported in the literature. CASE DESCRIPTION: We discuss the case of a 72 year old gentleman with prostate cancer who presented with a chronic subdural hematoma which was drained surgically. He was found to have disseminated intravascular coagulation (DIC) and recurrence of the subdural hematoma for which further drainage was required. After the second drainage of the chronic subdural hematoma, dural metastases were diagnosed from the pathology specimens. CONCLUSION: On reviewing the literature, 25 cases of dural metastases with chronic subdural hematoma and coagulopathy were found. These cases were characterized by the fact that they had a very poor clinical outcome in spite of surgical drainage. This combination could be a distinct entity and its recognition is important to guide management of this rare condition.